The study will develop meaningful quality measures for vulnerable individuals residing in residential care facilities (RCFs) and provide (a) quality improvement protocols that translate research into practice; (b) quality indicators to be used in external quality assurance systems, consumer report cards, and a performance feedback system for providers; and (c) the basis for an acuity-based reimbursement model. All of these components can be used in the purchase and improvement of the residential care and health services received by the aged and disabled residing in these facilities. Two states, which are working with the study team, are now actively engaged in policy development efforts directly related to the issues addressed in this study and will utilize the results of this study in their work. Other states will soon begin addressing the same issues. Thus, this study is both an effort develop useful quality measures for a vulnerable population and an exercise in translating research on quality measurement into the practice of quality improvement in operational settings to protect that population. The specific objectives of the project are: 1. To define and operationalize valid and reliable quality measures that can be used to evaluate the performance of residential care facilities (RCFs). 2. To covariance or risk-adjust the quality measures with relevant individual and organizational characteristics and develop facility-level measures of performance. 3. To develop facility- level report cards that can be used by: (a) facilities for quality improvement efforts; (b) consumers to select facilities; (c) payors to select or identify qualified facilities; and (d) regulatory agencies to target their oversight and enforcement activities. 4. To develop and test quality improvement protocols in selected areas essential to the quality of care and quality of life of residents. 5. To develop a resident classification model that could be used to adjust payment rates based on either an individual resident s acuity or the overall intensity of the facility s case-mix. 6. To disseminate study results to state policy-makers, provider associations, and consumer groups. In short, we propose a multi-faceted approach to developing and using quality measures to improve health care services to the vulnerable populations residing in RCFs.